Men's Health

Erectile Dysfunction Drugs Linked to Higher Rates of STDs

Sexually transmitted diseases (STDs) are a concern for middle-aged and older men who take erectile dysfunction (ED) medications such as Viagra, according to a new study.

The problem is not the medications but rather the high risk behaviors of the men who request them. Physicians should counsel these patients about safe sex practices, the researchers say.

Small studies of men who have sex with men have linked the use of ED drugs with higher risk behaviors and increased rates of STDs.

Understanding the Big Picture

The new report, published in the Annals of Internal Medicine, is said to be the first to look at the relationship between ED drugs and STD risk in a large, broad sample of privately insured older men.

"Primary care doctors don't usually talk to older men about safe sexual practices, and that's partly because rates of STDs are much lower in this group than in younger men," says study author Dr. Anupam B. Jena, at Massachusetts General Hospital in Boston.

"But what our findings suggest is that just by virtue of asking for an ED drug, these men are identifying themselves as being at two to three times higher risk of STDs," explains Dr. Jena.

Dr. Jena and his team reviewed health insurance claims records covering the years 1997 through 2006 from 44 large US employers. The study group included about 34,000 males over 40 who used ED medications, using information covering one year before and one year after the first prescription was filled.

It also looked at nearly 1.37 million men over 40 who were non-users of these medications, for whom claims data was also collected.

Men who had been prescribed an ED drug were two to three times more likely than non-users to have sexually transmitted diseases, and this was true both in the year before and after the first prescription was filled.

The most reported STD was HIV/AIDS, followed by chlamydia. The data gathered could not indicate whether ED drug use itself increased STD risk, but Dr. Jena says he is looking at that question in a separate study. One theory as to why HIV/AIDs is the most frequently-reported STD is that "the symptoms that are associated with a primary HIV infection are the kinds of things that make men more likely to show up to a doctor, rather than go to a free clinic where they know they can get tested for an STD anonymously."

Counseling Men about Risky Behaviors

Use of medications to treat ED has grown a great deal since the introduction of sildenafil, known as Viagra.

"This study confirms what we've suspected for a while, which is that the men who are using these drugs aren't just those who have erectile dysfunction, but they're also men in high risk groups who take it to enhance sexual activity," says Dr. Peter Leone, at the University of North Carolina. "So it's not that the drug is leading to the behavior. It's really the other way around."

The findings suggest a need for greater responsibility in prescribing ED medications, adds Dr. Leone. "Doctors need to realize that unless these patients are always using condoms or are in mutually monogamous relationships, they need routine STD screening with repeated follow-ups."

Always consult your physician or other healthcare provider for more information.

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September 2010

What is Erectile Dysfunction?

Impotence, or erectile dysfunction (ED), may result from the total inability to achieve erection, an inconsistent ability to achieve an erection, or the ability to only sustain a brief erection.

According to the National Institutes of Health (NIH), up to 30 million men are affected by ED, depending on the definition used.

For most men erectile dysfunction is caused by physical problems, usually related to the blood supply of the penis. Many advances have occurred in both diagnosis and treatment of ED.

According to the American Urological Association, a low testosterone level itself is rarely the cause of ED (5 percent or less), but low testosterone can be an added factor in many men who have other risk factors for ED.

Other risk factors for ED include medical problems such as hypertension, diabetes, vascular disease, and high levels of blood cholesterol. Smoking and drug and alcohol abuse also are risk factors for ED.

The US Food and Drug Administration (FDA) recommends that men follow general precautions before taking a medication for ED. Men who are taking medications that contain nitrates, such as nitroglycerin, should NOT use Viagra, Levitra, or Cialis.

Taking nitrates with one of these medications can lower blood pressure too much. In addition, men who take Levitra or Cialis should not use alpha blockers as they could result in hypotension (abnormally low blood pressure).

Experts recommend that men have a complete medical history and physical exam to determine the cause of ED. Men should tell their physician about all the medications they are taking - including over-the-counter medications.

In addition, men should not take these medications if they have a history of heart attack or stroke, or if they have a bleeding disorder or stomach ulcers.

Always consult your physician or other healthcare provider for more information.